Lecture 6 - Attention-Deficit/Hyperactivity Disorder (ADHD)

volitional inhibition deficit

problems with inattention and impulse control caused by brain abnormalities, the diagnosis at the time was minimal brain dysfunction focusing more of the hyperactive part of the disorder

DSM 5 criteria for ADHD

persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development, as characterized by 1 and or 2 of inattention, hyperactivity and impulsivity, it has to be present before age 12, needs to interfere with or reduce the quality of, social academic or occupational functioning, cant be explained by another mental disorder, has to affect you in multiple settings, with peers more emotion regulation that would impact your relationships

DSM 5 criteria for inattention

has to be present with 6 or more of the following symptoms, it often fails to give close attention to details, makes careless mistakes in schoolwork, at work or during other activities so it could be that you have a hard time with reading instructions, hard time connecting what you’ve been reading , not that you’re zoning out but profile of rushing through assignments, has difficulty sustaining attention in tasks or play activities (for every symptom could be a different reason why you have a hard time), often does not seem to listen when spoken to directly/zoning out in simple conversations, often does not follow through on instructions and fails to finish schoolwork, chores or duties in the work place (not paying attention to steps/slow processor), difficulty organizing tasks and activities, often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, loses things necessary for tasks or activities, easily distracted by extraneous stimuli and forgetful in daily tasks

DSM criteria for hyperactivity and impulsivity

fidgeting with or tapping hands or squirms in seat, leaves seat in situations where remaining seated is expected, runs about or climbs in situations where it is inappropriate (internal restlessness, need to move around), often unable to play or engage in leisure activities quietly (some are always talkative and making noises during leisurely activities like watching movies), is often on the go, acting as if driven by a motor (more about excess energy rather than straight up movement, talking excessively, blurting out an answer before a question has been completed (starting a task before even knowing what they’re supposed to be doing, wanting to predict what the person is saying/predicting each other’s sentences, has difficulty waiting his or her turn, interrupts or intrudes on others

what do you need in order to be diagnosed with the combined presentation of ADHD?

they have to exhibit at least 6 symptoms of inattention and at least 6 symptoms of hyperactivity/impulsivity

mother’s behaviors associated with ADHD risk?

using cigarettes, alcohol and other drugs during pregnancy, these are contributing factors rather than a causal association, the association is stronger for children who carry specific genetic risk

perinatal risks for ADHD

premature birth, low birth weight and complications with delivery involving hypoxia

medical history risk factors for ADHD

if a child has breathing problems during sleep but if breathing issues are fixed ADHD symptoms are still there but they are improved, exposure to low levels of lead

what is the main characteristic of the disorder?

deficient executive function

what are the most relevant executive function deficits in ADHD?

measures of response inhibition, vigilance, working memory and planning

WISC-IV

working memory index that can be used or processing speed cause children with ADHD perform more poorly on these factors

NEPSY-II

executive function assessment, kids that are really fast look at the items and remember it very fast, looking at a bunch of similar symbols and crossing it out as soon as you see the same one, lots of decision making and scanning what you see in front of you

continuous performance tests (CPTs)

sustained attention assessment, an omission indicates vigilance and a commission indicates impulsivity/pressing really fast for a distractor that is not the target, there is a norm comparison element where the CPT is a letter and distractors can be auditory or visual, this task considers attention, timeliness, impulsiveness and hyper-activity, it gives a visual report and if its a lot of omissions it gets red

impaired academic functioning

children with ADHD often have lower productivity, grades and scores on achievement tests are academic problems in ADHD due to ADHD symptoms, working memory deficits or both, working memory effects on academic performance increases rates of internalizing/externalizing problems

learning disorders in ADHD

very common, problem areas are usually related to reading, spelling and math, fluency is affected by overall processing speed abilities

children with ADHD and learning disability

reading is usually slower but accuracy is fast so they rush when reading misreading a lot of the words cause you are skipping over important details, they had more severe learning issues and more severe attention issues

children with ADHD but no learning disability

they had some degree of a learning disability

children with a learning disability but no ADHD

they had some degree of attentional problems

ADHD prevalence

lots of false positives, overdiagnosis and prescription of drugs, 2% of preschool kids, 6% of children and adolescents, 4% of adults have ADHD

issues with overdiagnosis

at the developmental level you have to wait till age 7 to diagnose ADHD, waiting for the right time cause unsure to depict if something is typical or atypical for kids of a certain age

partial remission ADHD

this is when you are diagnosed and at some point you don’t meet the criteria anymore, this is specifically when fewer than full criteria has been met for the past 6 months still results in impairment in social, academic or occupational functioning

mild ADHD

this is when there are few symptoms if any at all, symptoms are in excess of those needed to make the diagnosis are present and symptoms result in no more than minor impairments in social or occupational functioning

moderate ADHD

symptoms or functional impairment between mild and severe are present

severe ADHD

many symptoms in excess of those required to make the diagnosis or several symptoms that are particularly severe, are present or the symptoms result in marked impairment in social or occupational functioning

what are the different types of ADHD presentation?

combined, predominantly hyperactive-impulsive or predominantly inattentive

ADHD in women and girls

they are more likely to get rejected from their girl peers than boys do from their boy peers

impairment in organizing, prioritizing and activating

makes it hard to start things, hard to organize work and often misunderstand directions

impairment in focus, shift and sustained attention

often results in lose of focus when trying to listen, forgetting what has been read or need to reread and easily distracted

impaired in regulating alertness, effort and processing speed

excessive daytime drowsiness, difficulty completing a task on time and slow processing speed

impairment in managing frustration and modulating emotion

results in easily being irritated, feelings getting hurt easily and being overly sensitive to criticism

impairment in working memory and accessing recall

results in forgetting to do a planned task, difficulty following sequential directions and quickly losing thoughts that were put on hold

impairment in monitoring and regulating action

results in finding it hard to stay still or be quiet, rushing things, often interrupting or blurting things out

preschool ADHD symptoms

inattention would be if a child plays for short periods of time so like less than 3 mins, hyperactivity would look like being overactive and cant be settled so acting like a whirlwind, impulsiveness would look like not listening to adults warning and having no sense of danger

school-age symptoms of ADHD

inattention would look like activities are brief so less than 10 mins, being forgetful, disorganized, easily distracted, hyperactivity would look like being restless, excessive movement and leaving you seat in school, impulsiveness would look like blurting out answers in class, interrupting others and getting into many accidents

adolescence symptoms of ADHD

inattention would look like being less persistent in tasks than peers, not focusing on details and forgetting assignments, hyperactivity would look like having a subjective sense of restlessness and impulsiveness would look like being quick and unwise in decision making, impatient and reckless driving

what is the chief problem of ADHD

its not inattention but rather a lack/deficit in behavioral inhibition

how does ADHD impact workflow?

when someone is more busy there is a reduction in their symptoms cause the rush/adrenaline of having lots of things to get done keeps you occupied/stimulated enough

behavioral inhibition

ability to inhibit immediate responses, especially those that provide us with gratification, keep in mind there’s a long term goal, filter/type of barrier that is there

barkley’s neurodevelopmental model

behavioral disinhibition is affected by working memory, internalized speech, emotion regulation and creative problem solving (related to working memory which all makeup ADHD

genetics of ADHD

dopamine transporter gene and receptor gene mutation leading to cognitive dysfunction deficits, reward/motivation deficits, arousal level deficits and self-regulation deficits (can have the gene but expression is dependent on environmental conditions

pharmalogical treatment neurotransmitter involvement

dopamine and serotonin receptors are prevalent in behavioral inhibition and attention regulation brain regions, selective deficiency availability of dopamine and noradrenaline

affect of dopamine stimulation

it slows down your brain so it fixes the hyperactivity symptoms

adderall

it usually inhibits dopamine reuptake allowing it to remain in the synaptic cleft longer so more change to be detected by post synaptic cleft

mind wandering

more than inattention to tasks, it seems like time is skipping, spontaneous self generating thoughts that are independent of both the task and the environment, rich content, not the same thing as being distracted

mind blanking

no reportable mental content

both mind wandering and on task focus

executive resources could be necessary to sustain an internal train of thought

what were the discussion points of the mind wandering paper?

children with ADHD report more mind blanking than the control groups, the mind wandering is more focused on attention and executive functions, these are essential

how does ritalin affect mind wandering?

it reverts the level of mind blanking to baseline so it increases train of thought

default mode network

neural network responsible for task engagement is less effective, there is diminished arousal/arousability, in terms of measures of brain activity during vigilance tests there is under-responsiveness to stimuli/deficits in response inhibition, this indicates impaired synchronization between the default mode network and the task positive network

task positive network

part of the brain that activates when you focus on a task, it is involved in goal-directed behaviors like planning, decision making and problem solving

what are the two systems that govern your actions?

the behavioral inhibition system and the behavioral activation system, this is part of the pleasure pathway/mesolimbic neural circuit

behavioral inhibition system

slowing or stopping behavior in response to punishment or a lack of reinforcement, it helps conform to expectations of your environment

behavioral activation system

approaching stimuli and adjusting behavior to achieve reinforcement

the frontal-striatal neural circuit

delay in brain maturation, especially prefrontal regions, abnormalities in this region are implicated, this region includes the prefrontal cortex and the basal ganglia, children with ADHD children have smaller total and right cerebral volumes by 3-4% smaller, smaller cerebellum and delayed brain maturation